BLUKO82-Seeber March 13, 2007 17:50

Index

Page numbers in bold represent tables; those in italics represent figures.

10/30 rule, 4 ε- (EACA), 81 1-deamino-8-D-argine vasopressin (DDAVP). - (PAMBA), 81 see desmopressin anabolic steroids androgen therapy, 30 A-ANA. see augmented acute normovolemic defined, 21 hemodilution anaphylactic transfusion reactions, 252 acetylstarch, 70 androgen therapy, 30 acute hypervolemic hemodilution (AHH) anemia advantages/disadvantages, 204 acute vs. chronic, 14 defined, 200 adaptive mechanisms technique, 203–04 cardiac output, 14 acute normovolemic hemodilution (ANH) macrocirculation, 14–15 advanced use, 207 microcirculation, 15–17 advantages/disadvantages, 206–07 oxygen extraction, 15 allogenic transfusion exposure, 207 oxygen uptake, 15, 16 and coronary artery stenosis, 204 tissue oxygenation, 16 defined, 200 vascular tone, 14 fractionation, 207 causes history, 200–201 copper deficiency, 40 indications/eligibility, 204 hematinic deficiencies, 45–47 technique of, 204–05 inactivity, 162–63 troubleshooting, 205–06 iron deficiency, 38–40 adenosine triphosphate (ATP) generation, 13, 17 nutritional deficiencies, 46 AHH. see acute hypervolemic hemodilution pressure sores, 163 (AHH) riboflavin deficiency, 44 albumin clinical care pathway, 145 allergic reactions, 72 defined, 9 in AOCs, 115–16 pathophysiology of, 13–17 in impairment, 71 physiology of, 9–13 human, 271–72 preoperative treatment, 151 in recombinant blood products, 96–98, 103–04 primary prevention, 45–46 in volume therapy, 71 COPYRIGHTEDthresholds MATERIAL for, 9 albumin-based compounds, 87 anemia therapy alginate solutions, 71 androgen, 30 allergic reactions, in fluid therapy, 72 erythropoiesis-stimulating proteins allogenic transfusion. see also transfusions anabolic steroids, 30 defined, 243 EPO, 21–22 effects of, 250–55 NESP, 29–30 history, 4 prolactin, 31 outcome variables, 250–51 rHuEPO, 22–29 alloimmunization, 252 exercise in, 163 alveolar gas equation, 128 fluid therapy, 74

376 BLUKO82-Seeber March 13, 2007 17:50

Index 377

hematinics artificial oxygen carriers (AOCs) background, 35–36 in blood management, 119–20 copper therapy, 40 defined, 110 iron therapy, 36–40 hemoglobin-based, 111–16 hyperbaric oxygen, 136 history, 110–11 oxygen therapy, 135 perfluorocarbons, 116–19 therapy pillars, 18 artificial platelet substitutes, 120–21 anesthesiology, 191 ATP. see adenosine triphosphate (ATP) generation anesthetic measures augmented acute normovolemic hemodilution (A-ANA), controlled hypotension, 193–95 207. see also acute normovolemic hemodilution drug regimens, 196–97 (ANH) fluid restriction in, 197 autologous blood transfusion patient positioning, 192–93 defined, 200, 243 patient warming, 195–96 hemodilution, 203–07 PEEP, 196 history, 200–201 ventilation pattern adjustments, 196 platelet-/plasmapheresis, 207–08 anesthetist responsibilities, 191–92 preoperative donation, 201–03 angioneurotic edema, 271 autotransfusion, history, 4 ANH. see acute normovolemic hemodilution (ANH) balloon tamponade, 185 animal farming, 97 barometric pressure, 127 anticoagulation. see also coagulation Bethesda Units (BUs), 277 in cell salvage, 219 bioethics principles factors beneficence, 288–89 antithrombin III, 270 justice, 289 1-antitrypsine, 271 respect for persons, 288 C1-esterase inhibitor, 271 biologic recovery, 267 human albumin, 271–72 biotechnology, 96 immunoglobulins, 272–75 blood banking 1-proteinase inhibitor, 271 bank/clinician interaction, 239–40 protein C, 270–71 blood donation, 228–30 protein S, 271 blood safety, 230–34 history, 3, 4 blood separation, 235–39 preoperative management, 152 defined, 227 anti-D-immunoglobulin, 275 history, 227–28 antifibrinolytics maximum blood order schedule, 240 , 79–80 transfusion committee, 240 defined, 77 blood conservation EACA, 81 in blood management programs, 300, 304, 308, 316 PAMBA, 81 defined, 1 , 80–81 in phlebotomy, 162 antihemophilia factors (classical). see also recombinant clotting in plan of care, 148 factors blood donation rFIX, 99 donor recruitment, 228–29 rFVIIa, 99–102 process, 229–30 rFVIII, 98–99 replacement statistics, 229 antisera, 274–75 bloodless medicine/surgery, defined, 1 antithrombin III, 270 blood loss. see also iatrogenic blood loss 1-antitrypsine, 271 adaptive mechanisms, 13 –14 AOCs. see artificial oxygen carriers (AOCs) calculations, 147–48 aprotinin, 79–80 decubital ulcers in, 162 argon beam coagulator, 179 tissue adhesive effects, 86 BLUKO82-Seeber March 13, 2007 17:50

378 Index

blood management communication facilitation, 306–07 copper therapy, 40 education, 308–15 current/future practice, 5 hospital administration support, 305 defined, 1 initiator education, 300 HBOCs, 120–21 medical structure, 306 history, 1–2 plan champions, 304–05 iron therapy, 36–40 policies/procedures, 307–08 military uses, 2–3 blood management program, safety oxygen therapy, 135–36 evaluation/benchmarking, 318 PFCs in, 119–20 informed consent errors, 319 plasma fraction(s), 275–79 safety systems, 318–19 principles/laws in, 287–93 blood product contents recombinant blood products/proteins in, 98–105 FFP, 247 vitamin therapy, 40–45 platelets, 246–47 blood management program red cells, 245–46 administration, 5–6 blood safety layers coordinator’s role, 5–6 blood screening, 232 marketing donor education, 230 defined, 299 donor selection/deferral, 231 goals/targets, 315 faults in, 233 nurses’ role, 7 national vigilance systems, 231–32 policies/procedures, 6, 307–08 pathogen reduction, 232, 233 preoperative algorithm, 140 postdonation quarantine, 231 reasons/demand for, 5, 299 blood separation. see whole blood separation blood management program, administration blood storage data collection, 316–17 bacterial contamination, 234–35 priority setting, 315–16 irradiation, 235 routine tasks, 317–18 leukocyte reduction/depletion, 235 blood management program, education storage condition/time, 234 content/evaluation, 310 blood substitutes defined, 299 and AOCs, 111 methods/tools history, 65–66, 228 algorithms, 311–12 military uses, 3 clinical rounds, 311 blood volume conferences, 311 in AHH, 202–03 dedicated programs, 313 in ANH, 205 equipment/drug samples, 314 calculations, 147–48 lectures/grand rounds, 311 estimation methods, 147 one-on-ones, 310–11 and fluid therapy, 66 peer review/audit, 311 and phlebotomy, 161 printed material, 314 viscosity reduction, 14, 74 prospective review, 312 blood washing techniques reading assignments, 312–13 continuous, 215–16 role-plays, 314 discontinuous/intermittent, 214 self-education, 312 filtration, 216 videotapes, 313–14 Bohr effect, 16 needs assessment, 309–10 bone wax, 87–88 participants, 308–09 Boyle’slaw,127 blood management program, initiation BRAND mnemonic administrative structure, 306 alternatives, 255 business plan development, 300–304 decision making, 256–58 BLUKO82-Seeber March 13, 2007 17:50

Index 379

“no transfusion/therapy”, 255 platelet growth factors, 59 transfusion benefits, 248–50 protein C, 271 transfusion risks, 250–55 recombinant factor concentrates, 96–97 Bunsen solubility coefficient, 10 rFVIIa, 100 BUs. see Bethesda Units (BUs) coagulation. see also anticoagulation coaptive, 172 C1-esterase inhibitor, 271 electrocoagulation, 172 cancer factor mixes G-CSF/GM-CSF therapy in, 56 cryoprecipitate, 268 and growth factors, 57 prothrombin complex concentrate, 268 rHuEPO therapy in, 29 microwave, 177–78 transfusion risks, 250 obliterative, 172 tumor cells, 221–22 single factor concentrates cardiac output, 14 factor IX, 269 caregiver role. see iatrogenic blood loss factor VII, 270 cautery, 172 factor VIII, 269 Cavitron ultrasonic surgical aspirator (CUSA), 180 factor XI, 270 cell salvage factor XIII, 269–70 advantages, 217–18 fibrinogen, 269 anticoagulation, 219 prothrombin, 270 blood quality, 216–17 , 270 blood washing von Willebrand, 269 considerations, 218–19 surgical, 172 techniques, 214–16 in volume therapy, 71–72 cell-saving devices, 212–13 coagulopathies contraindications pharmacological, 153 amniotic fluid embolism, 222–23 preoperative treatment, 151–52 bacterial contamination, 221 tests for, 146 and concomitant diseases, 223 cobalamins, 42–43 tumor cells, 221–22 Cohn’s fractionation, 3 defined, 211 collagen, 88 direct/indirect, 212 colloid(s) filtration, 219 defined, 65 history, 211–12 history, 65 indications for, 223–24 solutions methods/devices, 3, 212–13 acetylstarch, 70 risks/side effects, 219–21 albumin, 71 cell-saving devices, 3, 212–13. see also cell salvage alginates, 71 Charles’ law, 127 dextran, 70 charters/bills/laws gelatins, 70–71 advance directive, 291 HES, 69–70 informed consent, 290–91 colony-stimulating factors, defined, 50 international examples, 289–90 compassionate use minors, 291–92 defined, 287 pregnancy/motherhood, 291 FDA protocol, 296 clinical trials compression and compassionate use, 287 balloon tamponade, 185 HBOCs, 115 bandaging, 184 hemostatic drugs, 85 manual wound, 183–84 increased FiO2, 205 mesh wrap, 184–85 interoperative plateletpheresis, 201 packing, 184 BLUKO82-Seeber March 13, 2007 17:50

380 Index

conjugated estrogens electrocautery defined, 77 defined, 172 as hemostatic drug, 84 tool, 176 controlled hypotension electrocoagulation, 172 concept of, 193–95 electrosurgery, 176–77 fluid restriction in, 193–94 electrothermal bipolar vessel sealing, 177 induction agents, 194 EPO. see erythropoietin (EPO) regional/epidural anesthesia in, 194 eptacog, 99–102 vasodilatation drugs in, 194 erythropoiesis copper deficiency/therapy, 40 EPO in, 22 coronary artery stenosis, 204 hematinics in, 35–36 Coumadin overdose, and FFP, 249 physiology of, 35 cryoprecipitate, 268 rHuEPO, 28 and FFP, 268 steps in, 22 and fibrinogen, 269 erythropoiesis-stimulating proteins in hemophilia therapy, 276 anabolic steroids, 30 in plasma fraction reduction, 279 EPO, 21–22 in von Willebrand disease, 277 NESP, 29–30 cryopreservation, in PAD, 202 prolactin, 31 crystalloid(s), 71 rHuEPO, 22–29 defined, 65 erythropoietin (EPO). see also recombinant human erythropoietin solutions (rHuEPO) brand names, 67 biological role, 24–25 classifications of, 67 defined, 21 glucose, 67–68 EPO receptor, 22 hypertonic fluids, 68–69 in erythropoiesis (normal), 21–22 sodium chloride 0.9%, 67 history, 21 CUSA, Cavitron ultrasonic surgical aspirator (CUSA) levels, 22 cutting devices. see surgical tools structure diagram, 30 cyanoacrylates, 88 erythropoietin hyporesponsiveness cytokines aluminum metabolism, 25 in adjuvant therapies, 26 causes, 25–26 defined, 50 diagrammed, 27 in erythropoiesis impairment, 28, 29 drug interference, 26 in erythropoietin hyporesponsiveness, 25 erythropoiesis levels, 25 IL-11, 53–54 hematinic deficiencies, 25–26 hyperparathyroidism, 25 Dalton’s law, 127 infection/inflammation, 25 darbepoetin. see novel erythropoiesis-stimulating protein (NESP) iron overload, 25 DDAVP. see desmopressin rHuEPO therapy in, 25 decubital ulcers, 162 erythropoietin resistance. see erythropoietin hyporesponsiveness desiccation, defined, 172 estrogens, conjugated, 77, 84 desmopressin, 81–82 ethics, 287. see also bioethics principles; charters/bills/laws dextran exercise, in anemia therapy, 163 in fluid therapy, 70 extracorporeal circuits (ECCs), 165–68 side effects, 71–72 diathermy, 172 Farhaeus effect, 11 drains, use of, 185 FCD. see functional capillary density (FCD) febrile nonhemolytic transfusion reaction (FNHTR), 250–51, 252 ε-aminocaproic acid (EACA), 81 FFP. see fresh-frozen plasma (FFP) ECCs. see extracorporeal circuits (ECCs) regional vs. general anesthesia, 197 electrical current, for surgery, 175–77 fibrinogen, 269 BLUKO82-Seeber March 13, 2007 17:50

Index 381

fibrinolysis for leukocytes in blood management, 78–79 G-CSF, 53–56 physiology of, 78 GM-CSF, 56–57 fibrin sealants, 87 in multilineal hematological failure management, 60–61 Fick’s law of diffusion, 10, 11 in neutropenia management, 60 FiO2. see inspiratory oxygen fraction (FiO2) for platelets fluid administration, in anesthetic measures, 197 cytokine combinations, 54 fluid therapy IL-11, 53–54 in anemia (severe), 74 rhuTOP, 53 in blood management, 73–74 thrombopoietin, 52–53 colloid solutions, 69–71 pluripotency of, 57, 58 crystalloid solutions, 67–69 in thrombocytopenia management, 57–60 fluid choice, 73 history, 65–66 Haldane effect, 10 hypertonic fluids, 68–69 Halstedian principles hypovolemia/hypervolemia, 73 history, 3 intravenous fluids, 67 tenets, 174 monitoring tools, 73 HBOCs. see hemoglobin-based oxygen carriers (HBOCs) need for, 65, 66–67 heat, in surgery, 175 polydisperse solutions, 69, 70 hematinic deficiencies resuscitation timing, 72–73 anemia therapy in, 46–47 solution effects, 73 iatrogenically induced, 46 vs. transfusion, 66–67 hematinics. see also iron therapy; vitamin therapy volume household, 67 adjunctive therapy, 47 FNHTR. see febrile nonhemolytic transfusion reaction and allogeneic transfusion, 45–46 (FNHTR) anemia prevention/therapy, 45–46 folates, 43–44 in blood management, 45–47 fresh-frozen plasma (FFP) copper therapy, 40 in blood product contents, 247 defined, 35 in hemophilia therapy, 276 in erythropoiesis, 35–36 side effects, 71–72 in hemoglobin synthesis, 35–36 in whole blood separation, 237 interactions of, 45 functional capillary density (FCD), 11 hematocrit reduction, 11 hematopoiesis G-CSF. see granulocyte colony stimulating factor (G-CSF) and copper deficiency, 40 gelatin diagrammed, 51 solutions, 70–71 EPO targets in, 22 as tissue adhesive/sealant, 88 growth factors, 50–52 glucose solutions, 67–68 and vitamins, 40, 45–46 granulocyte colony stimulating factor (G-CSF) hematopoieticcellgrowthfactors,50 recombinant forms, 54–56 hemihepatic vascular clamping, 182 synthesis of, 54 hemodilution granulocyte macrophage colony stimulating factor AHH, 203–04 (GM-CSF) ANH, 204–07 clinical use, 56–57 and coronary artery stenosis, 204 recombinant forms, 56 defined, 200 growth factors hemoglobin in blood management, 57–61 oxygen affinity factors, 12 concerns about, 57 in oxygen delivery, 13 for hematopoiesis relaxed/tense forms, 12 leukopoiesis, 52 synthesis, 35–36 megakaryopoiesis, 50–51, 55 types (human), 36 BLUKO82-Seeber March 13, 2007 17:50

382 Index

hemoglobin-based oxygen carriers (HBOCs) hormones, 84 in acute normovolemic hemodilution, 120 -group, 83–84 defined, 110 history, 77–78 effects of, 112–15 local agents, 86–90 in hemorrhagic shock, 120 physical/chemical measures, 89 new products, 115–16 tissue adhesive/sealant(s) potential indications, 115 albumin-based compounds, 87 properties of, 116–17 bone wax, 87–88 vs. red cell usage, 120 collagen, 88 in sickle cell anemia, 120 cyanoacrylates, 88 sources of, 111 fibrin sealants, 87 in surgical blood loss, 120 gelatin, 88 in trauma, 120 hydrogels, 88 hemoglobin solution effects microporous polysaccharide hemosphere, 88–89 on erythropoiesis, 114 , 88 hemostaseological alterations, 114 uses/application of, 89 on immune system, 114 topical agents, 90 infectious risks, 114 vasoconstrictors, 89–90 intravascular half-life, 114 hemostatic drugs oncotic effects, 113 antifibrinolytics, 78–81 oxidative damage, 114 in clinical trials, 85 oxygen affinity, 113 conjugated estrogens, 84 on renal system, 114 desmopressin, 81–82 rheological properties, 113 drug recommendations, 85 shelf life, 114 hormones, 84 vasopressor effects, 113–14 vitamin K-group, 83–84 viscosity, 113 hemostatics, defined, 77 hemolytic transfusion reactions, 253 hemovigilance, defined, 227 hemophilia Henry-Dalton equation, 10 antihemophilia factors, 98–105 Henry’s law, 127 and desmopressin, 82 hepatic vascular exclusion, selective, 182 plasma fraction(s) in, 276 hepcidin and recombinant blood products, 96 in iron metabolism, 37–38 hemorrhage treatment. see also hemostasis regulation of, 38 blood management, 3 HES. see hydroxyethyl starch (HES) coagulation factors, 268 heterologous transfusion, defined, 243 FFP, 260 hormones platelet transfusions, 259 defined, 50 hemorrhagic disease as hemostatic drugs, 84 in newborns, 83, 260 hot-jet coagulator, 175 hemostasis Hufner’s number, 9 achievement methods hydrogels, 88 compression, 183–85 hydroxyethyl starch (HES) drains, 185 classifications of, 70 patient positioning, 186 history, 66 vessel occlusion, 181–83 pharmacology of, 69–70 hemostatic drugs side effects, 70, 72 antifibrinolytics, 78–81 substitution degree, 69 in clinical trials, 85 hyperbaric oxygen therapy conjugated estrogens, 84 in anemia (severe), 136 desmopressin, 81–82 chambers for, 133 drug recommendations, 85 contraindications, 133 BLUKO82-Seeber March 13, 2007 17:50

Index 383

defined, 125 in normobaric conditions, 132 indications, 132–33 physiology, 10, 127 recommendation measures, 134–35 interleukin 11 (IL-11), 53–54. see also recombinant human in sickle cell crisis, 136 interleukin 11 (rhuIL-11) treatment patterns, 133–34 interleukins, defined, 50 hyperchloremic metabolic acidosis, 72 international unit (IU), 267 hyperimmune immunoglobulins of human origin, 274 intravascular recovery, 267 hypertonic fluids, 68–69 intravenous immunoglobulins of human origin (IVIG), hypovolemia/normovolemia, 13–14 273–74 hypoxia investigational new drug (IND) and EPO, 22 compassionate use of, 296 and tissue oxygenation, 16–17 defined, 287 iron iatrogenic blood loss absorption, 38 in blood management, 168 deficiency causes absolute/relative/functional, 38 diagnostic interventions, 164 differential diagnosis, 42 ECCs, 165–66 markers of, 39 elapsed time, 167–68 defined, 35 inactivity/bed rest, 162–63 metabolism, 37–38 , 164–65 physiology, 36–38 phlebotomy, 160–62 therapeutic use, 38–39 stress, 163–64 therapy defined, 160 essays for, 41–42 drug effects on, 165 intravenous preparations, 39 reduction strategies oral preparations, 38–39 ambulation/exercise, 163 parenteral iron formulas, 40 choice, 164–65 physiology, 36–38 phlebotomy amount/volumes, 162–63 side effects, 38–39 ulcer prophylaxis, 163–64 uses of, 38–39 vascular access skill/methods, 164 IU. see international unit (IU) IL-11. see interleukin 11 (IL-11) IVIG. see intravenous immunoglobulins of human origin immunoglobulin monomer, 272 (IVIG) immunoglobulins anti-D-immunoglobulin, 275 Jehovah’s Witnesses antisera, 274–75 blood acceptance attitudes, 295 IVIG, 273–74 and bloodless medicine, 1–2 immunological reactions hospital liaison committees, 2 alloimmunization, 252 medical care attitudes, 293 to anaphylactic transfusions, 252 physician care of, 2, 293–95 FNHTR, 252 support for patients/physicians, 295–96 to hemolytic transfusions, 253 microchimerism, 253–54 post-transfusion purpura, 254 kidney function, and fluid therapy, 72 TA-GvHD, 253 kinetic energy, in surgery, 179–80 transfusion-related acute lung injury, 253 IND. see investigational new drug (IND) laser surgery, 178–79 infrared contact coagulator, 178 L-Carnitine, 44–45 inhalation oxygen therapy, 125. see also normobaric oxygen leukopoiesis, 52 inhalation therapy lightning inspiratory oxygen fraction (FiO2) argon beam coagulation, 179 in hyperbaric conditions, 129 and plasma scalpel, 179 BLUKO82-Seeber March 13, 2007 17:50

384 Index

light, surgical novel erythropoiesis-stimulating protein (NESP) infrared contact coagulator, 178 defined, 21 laser, 178–79 effects, 30 local hemostatic agents, 86–90 lysine derivatives obliterative coagulation, 172 EACA, 81 octocog, 98–99 PAMBA, 81 oprelvekin. see interleukin 11 (IL-11) tranexamic acid, 80–81 organized programs. see blood management program terms macrocirculation. see oxygen delivery/transport orphan drug, defined, 265 Makuuchi’s maneuver, 182 oxidized cellulose, 88 malignancy. see cancer oxygen MANAGER mnemonic, 279–81 consumption, 13 manual wound compression, 183–84 delivery/consumption relationship, 17 megakaryopoiesis, 50–51, 55 dissociation curve, 12 megapoietin. see thrombopoietin extraction, 15 mesh wrap, 184–85 extraction ratio, 13 microchimerism, 253–54 gas laws, 127–28 microcirculation. see oxygen uptake; tissue oxygenation hyperbaric conditions, 129–30 microporous polysaccharide hemosphere, 88–89 physics/physiology of, 127–28 microvasculature oxygen delivery/transport. see also oxygen uptake and HBOCs, 113 Bunsen solubility coefficient, 10 HES solution effects, 70 equation, 9, 17 oxygen delivery to, 11–12, 15–16 FiO2,10 and viscosity increases, 74 flow, 9 microwave coagulation, 177–78 hemoglobin, 9–10, 13 military uses Henry-Dalton equation, 10 blood management, 2–3 to microvasculature, 11 blood substitutes, 3, 111 by perfluorocarbons, 118–19 transfusion medicine, 3 oxygen therapy mineral zeolite, 89 in anemia/hemorrhagic shock, 135 minors, decision making of, 291–92 in blood management, 135–36 mitochondria, oxygen utilization factors, 13 defined, 125 modified hemoglobin solutions, 112 drug interactions, 129 multilineal hematological failure management, 60–61 effects on human body myoglobin-facilitated oxygen diffusion, 13 cerebral, 128 circulatory, 128 NESP. see novel erythropoiesis-stimulating protein (NESP) immunological, 128 neutropenia metabolic, 128 and copper deficiency, 40 ocular, 128 G-CSF/GM-CSF therapy in, 56 oxygen toxicity, 129 granulocyte transfusions in, 260 of pressurized oxygen, 129–30 and growth factors, 57 pulmonary, 129 management of, 60 history, 125–27 normal saline, 67 hyperbaric oxygen treatment, 125, 132–35 normobaric oxygen inhalation therapy hyperoxic ventilation, 135 diagnostic measures, 130 normobaric oxygen inhalation, 130–32 indications, 130 oxygen uptake oxygen delivery systems, 131–32 in anemia, 15 oxygen mixing, 131 carbon dioxide release, 10 oxygen supply, 130–31 Fick’s law of diffusion, 10, 11 recommendations for, 132 Haldane effect, 10 BLUKO82-Seeber March 13, 2007 17:50

Index 385

pulmonary gas exchange, 10, 15 example plan, 149–51 by red cells, 10–12 problem list, 148 by tissues, 12–13, 16–17 therapeutic options, 149 treatment/therapy goals, 148 packing, 184 plasma PAD. see preoperative autologous donation (PAD) anatomy of, 266 -aminomethylbenzoic acid (PAMBA), 81 substitutes, defined, 65 patient plasma-derived blood proteins, 106 history plasma fractionation anemia symptoms, 141 chromatography, 238–39 bleeding disorders, 141–42 precipitation, 238 body systems review, 142–43 production methods, 239 chief complaint, 141–42 plasma fraction(s) demographics, 141 anticoagulation factors, 270–75 drug/supplement list, 143 antithrombin III, 270 food/drug allergies, 143 C1-esterase inhibitor, 271 hemostasis, obstacles to, 142 human albumin, 271–72 overview, 139–40 immunoglobulins, 272–75 screening questionnaire, 142 protein C, 270–71 positioning protein S, 271 in anesthetic measures, 192–93 blood management for hemostasis, 186 in congenital clotting factor deficiencies, 278 rights, 287 general, 275–76 PCC. see prothrombin complex concentrates (PCC) in hemophilia, 276 PEEP. see positive end-expiratory pressure (PEEP) inhibitor treatment, 276–77 pegylated recombinant human megakaryocyte growth and in liver-related coagulopathies, 278 development factor (PED-rhuMGDF), 53 in vitamin K deficiency, 278 perfluorocarbons (PFCs), 119–20 in von Willebrand disease, 277 A-ANA, 120–21 coagulation factors in anemia (severe), 119 cryoprecipitate, 268 in blood management, 119–20 factor IX concentrates, 269 characteristics of, 116–18 factors XIII, 269–70 defined, 110 factor VII, 270 history, 111 factor VIII concentrate, 269 oxygen delivery by, 118–19 factor XI, 270 in sickle cell anemia, 120 fibrinogen, 269 tested/potential indications, 119 prothrombin, 270 PFCs. see perfluorocarbons (PFCs) prothrombin complex concentrate, 268 pharming, 97 thrombin, 270 phlebotomy-induced blood loss von Willebrand factor concentrates, 269 “bloodless” monitoring, 162 concept of, 266–68 education/policies, 162 defined, 265 and laboratory tests, 160 in disseminated intravascular coagulation, reduction of, 161–62 278–79 physicians. see also iatrogenic blood loss history, 265–66 bloodless treatment development, 2 in other blood product reduction, 279 conscience of, 292–93 use reduction, 279–81 and Jehovah’s Witnesses, 2 plasma-/platelet-sequestration, 200 transfusion decision making, 244–45 plasma scalpel, 179 plan of care platelet-/plasmapheresis computer-based planning, 149 advantages/disadvantages, 208 emergency planning, 149 techniques, 207 BLUKO82-Seeber March 13, 2007 17:50

386 Index

platelet(s) recombinant clotting factors. see also antihemophilia factors disorders, 82 (classical) growth factors, 52–54 fibrinogen, 103 maturation process, 51 rFXIII, 103 and megakaryocytes, 50–52 rhAT, 103 substitutes, 120–21 rHb, 104–05 synthesis, 52 rHSA, 103–04 plus-minus-implications (PMI), in transfusion decision, 256 thrombin, 103 polycythemia, 151 recombinant drugs, defined, 96 polydisperse solutions, 69, 70 recombinant factor IX (rFIX), 99 positive end-expiratory pressure (PEEP), 196 recombinant factor VIIa (rFVIIa) potency, in plasma fractionation, 265, 267 dose regimen, 102 preoperative algorithm, 140 off-label uses, 101 preoperative autologous donation (PAD) vs. other recombinant factors, 99 advantages/disadvantages, 202–03 recommended uses, 100–102 blood collection/storage, 202 as “universal” hemostatic agent, 99 costs of, 203 recombinant factor VIII (rFVIII), 98–99 cryopreservation, 202 recombinant factor XIII (rFXIII), 103 defined, 200 recombinant hemoglobins (rHb), 104–05 eligibility for, 201 recombinant human antithrombin (rhAT), 103 erythropoiesis stimulation, 202–03 recombinant human erythropoietin (rHuEPO) predonation iron therapy, 202 adjuvant therapies, 26 in pregnancy, 203 application, 23 program administration, 201–02 benefits, 26–29 retransfusion issues, 202 defined, 21 side effects, 203 dosage/response, 23, 24 pressure sores, in blood loss, 162–63 as a drug, 22–26 pressurized oxygen, effects of, 129–30 history, 21 principles/laws metabolization, 23 bioethics, 288–89 replacement methods (future), 29 charters/bills/laws, 289–92 side effects, 23–24 in decision making, 287 supplements to, 26 human/patients’ rights, 289 synthetic production, 23 pyramid of principles, 288 and transfusions, 29 Pringle maneuver, 181 recombinant human interleukin 11 (rhuIL-11), 53–54 program, defined, 299 recombinant human prolactin, 31 prolactin, 31 recombinant human serum albumin (rHSA), 103–04 1-proteinase inhibitor, 271 recombinant human thrombopoietin (rhuTPO), 53 protein C, 270–71 red cells protein S, 271 in microcirculation prothrombin, 270 pathophysiology, 13–17 prothrombin complex concentrates (PCC), 268 regular physiology, 9–13 pulmonary gas exchange, 10, 15 oxygen release, 12–13, 16 purity, of plasma, 267 oxygen uptake, 10, 15 purpura, post-transfusion, 254 tissue oxygenation, 11, 15 replacement fluids, colloid solutions as, 67 recombinant blood products/proteins rFVIIa. see recombinant factor VIIa (rFVIIa) history, 96 rFVIII. see recombinant factor VIII (rFVIII) vs. plasma-derived blood proteins, 106 rFIX. see recombinant factor IX (rFIX) production of, 97–98 rFXIII. see recombinant factor XIII (rFXIII) safety, 98 rhAT. see recombinant human antithrombin (rhAT) vaccines/sera/immunoglobulins, 105 rHb. see recombinant hemoglobins (rHb) BLUKO82-Seeber March 13, 2007 17:50

Index 387

rHSA. see recombinant human serum albumin (rHSA) therapeutic options, 149 rHuEPO. see recombinant human erythropoietin (rHuEPO) treatment/therapy goals, 148 rhuTPO. see recombinant human thrombopoietin preoperative workups (rhuTPO) of accompanying disorders, 145–46 riboflavin, 44 of anemia, 144 rouleaux formations, 11 of impaired clotting, 144–45 surgical coagulation, 172 safety. see blood management program, safety surgical cutting saline-enhanced thermal sealing, 177 blood loss impact, 180 scalpels device comparison, 181 hemostatic, 176 vibration in, 180 plain, 175 surgical techniques plasma, 179 Halstedian principles, 174 ultrasonic/harmonic, 180 heat, 175 Seldinger’s technique, 164 history, 172–74 sodium chloride 0.9% (normal saline), 67 and patient outcomes, 174 specific activity surgeon selection, 174 described, 267 technique selection, 174 in factor VIII concentrate, 269 tools, 175 stress ulcers, in blood loss, 163 surgical tools substitution degree argon beam coagulator, 179 of HES, 69 electrical current, 175–77 surgery preparation electrocautery, 176 calculations electrosurgery, 176–77 blood loss, allowable, 148 heat, 175 blood loss, expected, 147 ideal characteristics, 175 blood/red cell volume, 147–48 kinetic energy, 179–80 minimum hemoglobin/hematocrit, 148 light, 178–79 clinical care pathway, 145 microwaves, 177–78 equipment preparation, 154, 156 scalpels laboratory tests, 144–46 hemostatic, 176 patient history plain, 175 anemia symptoms, 141 plasma, 179 bleeding disorders, 141–42 ultrasonic/harmonic, 180 body systems review, 142–43 thermocoagulator, 175 chief complaint, 141–42 survival study, described, 267 demographics, 141 sympathetic nerve stimulation, 14 drug/supplement list, 143 food/drug allergies, 143 TACO. see transfusion-associated circulatory overload (TACO) hemostasis, obstacles to, 142 TA-GvHD. see transfusion-associated graft-versus-host disease overview, 139–40 (TA-GvHD) screening questionnaire, 142 thermal knife, 172 patient preparation thermocoagulator, 175 adverse condition treatment, 151–54 thrombin, 270 education, 154 thrombocytopenia surgical field optimization, 154 management of, 57–60 physical examination, 143–44 treatment measures, 59 plan of care thrombocytopenic bleeding, 82 computer-based planning, 149 thrombopoietin. see also recombinant human thrombopoietin emergency planning, 149 (rhuTPO) example plan, 149–51 PEG-rhuMGDF in, 53 problem list, 148 in platelet synthesis, 52 BLUKO82-Seeber March 13, 2007 17:50

388 Index

through level, in coagulation factors, 267 PMI, 256 tissue adhesive/sealant(s) tools, 245, 256–58 albumin-based compounds, 87 defined, 243 bone wax, 87–88 guidelines collagen, 88 FFP, 260 cyanoacrylates, 88 granulocytes, 259–60 defined, 77 leukoreduction in, 260 fibrin sealants, 87 platelets, 259 gelatin, 88 red cells, 258–59 hydrogels, 88 and hematinic therapy, 46–47 microporous polysaccharide hemosphere, 88–89 history, 243–44 mineral zeolite, 89 microcirculation effects, 250–51 oxidized cellulose, 88 and rHuEPO, 29 use of, 89 risks/side effects tissue glue. see tissue adhesive/sealant(s) allogenic transfusion effects, 250–55 tissue oxygenation bacterial contamination, 252 ANH in, 206–07 circulatory effects, 254 and fluid therapy, 73–74 clerical error, 252 and hemodilution, 16 immunological reactions, 252–54 PFCs in, 119 immunomodulatory effects, 254–55 physiology, 11–13 iron overload, 254 and transfusion decision, 247–50 outcome variables, 250–51 total vascular exclusion, 181 specialists, 4 TRALI. see transfusion-related acute lung injury (TRALI) “triggers”, 244–45, 247–48 tranexamic acid, 80–81 and volume replacement, 73 transferrin, 27 transfusion-transmittable infections (TTIs), 251–52 in erythropoietin hyporesponsiveness, 25 TRIM. see transfusion-related immunomodulation (TRIM) essays for iron therapy, 41 TTIs. see transfusion-transmittable infections (TTIs) and hepcidin regulation, 38 in iron deficiency, 42 ultrasonic/harmonic scalpel, 180 in iron physiology, 36–37 saturation, 39 vaccines/sera/immunoglobulins, 105 transfusion-associated circulatory overload (TACO), vascular tone, 14 254 ventilation pattern choices, 196 transfusion-associated graft-versus-host disease (TA-GvHD), vessel occlusion methods 253 embolization, 182 transfusion-free medicine/surgery, defined, 1 endovascular grafts, 182 transfusion medicine sutures/clips, 181 history, 4 tourniquet, 182 military development of, 3 vascular maneuvers transfusion-related acute lung injury (TRALI), 253 hemihepatic vascular clamping, 182 transfusion-related immunomodulation (TRIM), hepatic vascular exclusion, selective, 182 250 Makuuchi’s maneuver, 182 transfusions. see also BRAND mnemonic Pringle maneuver, 181 alternatives, 4, 255 total vascular exclusion, 181 benefits, 248–50 vitamin therapy blood product contents, 245–47 cobalamins (vitamin B12), 42–43 decision making folates, 43–44 biases, 257–58 L-Carnitine, 44–45 grid analysis, 256–57 riboflavin, 44 options, 256 role of, 40–42 by physicians, 244–45 vitamin A, 45 BLUKO82-Seeber March 13, 2007 17:50

Index 389

vitamin-B group, 45 von Willebrand factor concentrates, 269 vitamin C, 44 vitamin E, 45 warming, of patients, 195–96 vitamin K, 45, 78, 83–84 white cells, maturation process, 51 volume therapy whole blood separation defined, 65 additives, 236 side effects FFP, 237 coagulation, 71–72 granulocytes, 237 hyperchloremic metabolic acidosis, 72 plasma fractionation, 238–39 kidney function, 72 platelet concentrates, 236–37 von Willebrand disease process, 235–36 and conjugated estrogens, 84 red cell concentrates, 236 and desmopressin, 82 window period, defined, 227 BLUKO82-Seeber March 13, 2007 17:50

390